Operate, actions
Actions
Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.
Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed
Actions
26,640 derived from the last resolution run
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-015045 | Outreach suppressed pending steward Outreach | CLM-412695 (Isabella Torres) held until CASE-001601 is decided |
| Held | — | ||
| ACT-015046 | Outreach suppressed pending steward Outreach | TPA-50703 (Eric Wood) held until CASE-001602 is decided |
| Held | — | ||
| ACT-015047 | Outreach suppressed pending steward Outreach | PRV-24580 (Maria Vazquez) held until CASE-001603 is decided |
| Held | — | ||
| ACT-015048 | Outreach suppressed pending steward Outreach | CLM-418639 (Natalie Hoffman) held until CASE-001604 is decided |
| Held | — | ||
| ACT-015049 | Outreach suppressed pending steward Outreach | CLM-418640 (Natalie Hoffman) held until CASE-001605 is decided |
| Held | — | ||
| ACT-015050 | Outreach suppressed pending steward Outreach | CLM-420999 (Tyler Reed) held until CASE-001606 is decided |
| Held | — | ||
| ACT-015051 | Outreach suppressed pending steward Outreach | TPA-59237 (Tyler Reed) held until CASE-001607 is decided |
| Held | — | ||
| ACT-015052 | Outreach suppressed pending steward Outreach | TPA-50049 (Dylan Reed) held until CASE-001608 is decided |
| Held | — | ||
| ACT-015053 | Outreach suppressed pending steward Outreach | CLM-409066 (Steve Scott) held until CASE-001609 is decided |
| Held | — | ||
| ACT-015054 | Outreach suppressed pending steward Outreach | CLM-416035 (Mateo Chen) held until CASE-001610 is decided |
| Held | — | ||
| ACT-015055 | Outreach suppressed pending steward Outreach | TPA-61201 (Sandra Knight) held until CASE-001611 is decided |
| Held | — | ||
| ACT-015056 | Outreach suppressed pending steward Outreach | ENR-133202 (Sandra Knight) held until CASE-001612 is decided |
| Held | — | ||
| ACT-015057 | Outreach suppressed pending steward Outreach | TPA-59746 (Janet Knight) held until CASE-001613 is decided |
| Held | — | ||
| ACT-015058 | Outreach suppressed pending steward Outreach | PRV-26573 (Terry Kennedy) held until CASE-001614 is decided |
| Held | — | ||
| ACT-015059 | Outreach suppressed pending steward Outreach | TPA-63457 (Virginia Wheeler) held until CASE-001615 is decided |
| Held | — | ||
| ACT-015060 | Outreach suppressed pending steward Outreach | ENR-140011 (Virginia Wheeler) held until CASE-001616 is decided |
| Held | — | ||
| ACT-015061 | Outreach suppressed pending steward Outreach | TPA-59199 (Nancy Freeeman) held until CASE-001617 is decided |
| Held | — | ||
| ACT-015062 | Outreach suppressed pending steward Outreach | TPA-60803 (Melissa White) held until CASE-001618 is decided |
| Held | — | ||
| ACT-015063 | Outreach suppressed pending steward Outreach | TPA-60804 (Melissa White) held until CASE-001619 is decided |
| Held | — | ||
| ACT-015064 | Outreach suppressed pending steward Outreach | CLM-431613 (Logan Hamilton) held until CASE-001620 is decided |
| Held | — | ||
| ACT-015065 | Outreach suppressed pending steward Outreach | ENR-141509 (Logan Hamilton) held until CASE-001621 is decided |
| Held | — | ||
| ACT-015066 | Outreach suppressed pending steward Outreach | TPA-60429 (Mason Alvarez) held until CASE-001622 is decided |
| Held | — | ||
| ACT-015067 | Outreach suppressed pending steward Outreach | TPA-53989 (Kevin Taylor) held until CASE-001623 is decided |
| Held | — | ||
| ACT-015068 | Outreach suppressed pending steward Outreach | CLM-409153 (Kevin Tailor) held until CASE-001624 is decided |
| Held | — | ||
| ACT-015069 | Outreach suppressed pending steward Outreach | ENR-135620 (Nancy Crawford) held until CASE-001625 is decided |
| Held | — | ||
| ACT-015070 | Outreach suppressed pending steward Outreach | CLM-427163 (Nancy Crawford) held until CASE-001626 is decided |
| Held | — | ||
| ACT-015071 | Outreach suppressed pending steward Outreach | CLM-408977 (Bobby Gray) held until CASE-001627 is decided |
| Held | — | ||
| ACT-015072 | Outreach suppressed pending steward Outreach | CLM-410881 (Abigail Gray) held until CASE-001628 is decided |
| Held | — | ||
| ACT-015073 | Outreach suppressed pending steward Outreach | CLM-410880 (Abigail Gray) held until CASE-001629 is decided |
| Held | — | ||
| ACT-015074 | Outreach suppressed pending steward Outreach | ENR-115973 (Lawrence Garza) held until CASE-001630 is decided |
| Held | — | ||
| ACT-015075 | Outreach suppressed pending steward Outreach | CLM-409655 (Dilan Berry) held until CASE-001631 is decided |
| Held | — | ||
| ACT-015076 | Outreach suppressed pending steward Outreach | CLM-418247 (Juan Estrada) held until CASE-001632 is decided |
| Held | — | ||
| ACT-015077 | Outreach suppressed pending steward Outreach | TPA-54073 (Walter Morrison) held until CASE-001633 is decided |
| Held | — | ||
| ACT-015078 | Outreach suppressed pending steward Outreach | TPA-54074 (Walter Morrison) held until CASE-001634 is decided |
| Held | — | ||
| ACT-015079 | Outreach suppressed pending steward Outreach | CLM-409404 (Walter Mrrison) held until CASE-001635 is decided |
| Held | — | ||
| ACT-015080 | Outreach suppressed pending steward Outreach | CLM-413973 (Kennteh Gibson) held until CASE-001636 is decided |
| Held | — | ||
| ACT-015081 | Outreach suppressed pending steward Outreach | CLM-405586 (Marcus Bryant) held until CASE-001637 is decided |
| Held | — | ||
| ACT-015082 | Outreach suppressed pending steward Outreach | ENR-107343 (Marcus Bryant) held until CASE-001638 is decided |
| Held | — | ||
| ACT-015083 | Outreach suppressed pending steward Outreach | ENR-118362 (Victoria Reyes) held until CASE-001639 is decided |
| Held | — | ||
| ACT-015084 | Outreach suppressed pending steward Outreach | TPA-56192 (Victoria Reyes) held until CASE-001640 is decided |
| Held | — | ||
| ACT-015085 | Outreach suppressed pending steward Outreach | CLM-400115 (Samuel Reyes) held until CASE-001641 is decided |
| Held | — | ||
| ACT-015086 | Outreach suppressed pending steward Outreach | ENR-100165 (Samuel Reyes) held until CASE-001642 is decided |
| Held | — | ||
| ACT-015087 | Outreach suppressed pending steward Outreach | TPA-53324 (Judith Boyd) held until CASE-001643 is decided |
| Held | — | ||
| ACT-015088 | Outreach suppressed pending steward Outreach | TPA-55728 (Julia Jackson) held until CASE-001644 is decided |
| Held | — | ||
| ACT-015089 | Outreach suppressed pending steward Outreach | PRV-28400 (Maria Jackson) held until CASE-001645 is decided |
| Held | — | ||
| ACT-015090 | Outreach suppressed pending steward Outreach | TPA-62633 (Maria Jackson) held until CASE-001646 is decided |
| Held | — | ||
| ACT-015091 | Outreach suppressed pending steward Outreach | TPA-51997 (Sofia Luna) held until CASE-001647 is decided |
| Held | — | ||
| ACT-015092 | Outreach suppressed pending steward Outreach | TPA-61394 (Stephanie Chapman) held until CASE-001648 is decided |
| Held | — | ||
| ACT-015093 | Outreach suppressed pending steward Outreach | TPA-61553 (Kelly Carlson) held until CASE-001649 is decided |
| Held | — | ||
| ACT-015094 | Outreach suppressed pending steward Outreach | CLM-412939 (Mariana Sullivan) held until CASE-001650 is decided |
| Held | — |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.